Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
Circulation. 2013 May 21;127(20):2031-7. doi: 10.1161/CIRCULATIONAHA.112.000483. Epub 2013 Apr 18.
Acute aortic dissection is a preventable life-threatening condition. However, there have been no prospective population-based studies of incidence or outcome to inform an understanding of risk factors, strategies for prevention, or projections for future clinical service provision.
We prospectively determined incidence and outcomes of all acute aortic dissections in a population of 92 728 in Oxfordshire, United Kingdom, from 2002 to 2012. Among 155 patients with 174 acute aortic events, 54 patients had 59 thoracoabdominal aortic dissections (52 incident events: 6/100 000, 95% confidence interval, 4-7; 37 Stanford type A, 15 Stanford type B; 31 men, mean age=72.0 years). Among patients with type A incident events, 18 (48.6%) died before hospital assessment (61.1% women). The 30-day fatality rate was 47.4% for patients with type A dissections who survived to hospital admission and 13.3% for patients with type B dissections, although subsequent 5-year survival rates were high (85.7% for type A; 83.3% for type B). Even though 67.3% of patients were on antihypertensive drugs, 46.0% of all patients had at least 1 systolic BP ≥180 mm Hg in their primary care records over the preceding 5 years, and the proportion of blood pressures in the hypertensive range (>140/90 mm Hg) averaged 56.0%. Premorbid blood pressure was higher in patients with type A dissections that were immediately fatal than in those who survived to admission (mean/standard deviation pre-event systolic blood pressure=151.2/19.3 versus 137.9/17.9; P<0.001).
Uncontrolled hypertension remains the most significant treatable risk factor for acute aortic dissection. Prospective population-based ascertainment showed that hospital-based registries will underestimate not only incidence and case fatality, but also the association with premorbid hypertension.
急性主动脉夹层是一种可预防的危及生命的疾病。然而，目前还没有前瞻性的基于人群的发病率或结局研究来了解危险因素、预防策略或未来临床服务提供的预测。
我们前瞻性地确定了 2002 年至 2012 年在英国牛津郡的 92728 人中所有急性主动脉夹层的发病率和结局。在 155 例 174 例急性主动脉事件患者中，54 例患者发生 59 例胸主动脉夹层（52 例为首发事件：6/100000，95%置信区间，4-7；37 例 Stanford 型 A，15 例 Stanford 型 B；31 例男性，平均年龄为 72.0 岁）。在首发事件的 A 型患者中，18 例（48.6%）在医院评估前死亡（女性占 61.1%）。存活至住院的 A 型夹层患者的 30 天死亡率为 47.4%，B 型夹层患者的死亡率为 13.3%，尽管随后的 5 年生存率较高（A 型为 85.7%；B 型为 83.3%）。尽管 67.3%的患者正在服用降压药物，但在过去 5 年中，所有患者中有 46.0%的患者在初级保健记录中至少有 1 次收缩压≥180mmHg，且高血压范围（>140/90mmHg）的血压比例平均为 56.0%。在立即致命的 A 型夹层患者中，发病前的血压明显高于存活至入院的患者（发病前收缩压的平均/标准差=151.2/19.3 比 137.9/17.9；P<0.001）。
未控制的高血压仍然是急性主动脉夹层最重要的可治疗危险因素。基于人群的前瞻性确定表明，基于医院的登记处不仅会低估发病率和病死率，还会低估与发病前高血压的关联。
